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Does Government Promote Heroin Use?

The Dayton Daily News, summarizing a new report from the Ohio Substance Abuse Monitoring Network, says narcotic painkillers are a gateway to heroin:

Heroin use has increased in the past six months in Dayton and statewide. The report attributes the spike in part to the wide availability of opioid prescriptions, which often lead to addiction and then heroin use when pills become too expensive....

Robert Masone, a pain specialist and president of the Ohio Society of Interventional Pain Physicians, said because two or three OxyContin 80 milligram pills can cost up to $200, many addicts are forced to seek other alternatives when money is scarce.

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"When they can get that money, that's what they prefer. When they can't there's always a heroin pusher out there offering them a single dose of heroin," Masone said.

The state's spin on this finding is that overprescription of opioids leads to heroin use. But there is another implication as well: To the extent that the government is successful at preventing "diversion," making painkillers harder to come by and more expensive, it encourages current users to switch to an illegal drug that is more dangerous because dose and quality are unpredictable in a black market. The Dayton Daily News gives an example:

Ross [a methadone clinic counselor] attributed the low price [of heroin] to the fact that there is very little pure heroin in many of the batches found in Dayton. "They are cutting with anything," she said, citing one recent case where a woman was hospitalized after injecting heroin cut with drywall powder.

In addition to enforcement aimed at discouraging opioid prescriptions, the paper says, the reformulation of OxyContin, which now yields a gel when crushed instead of a powder, may have encouraged a shift toward heroin. Since efforts to stop nonmedical use of prescription painkillers seem to be making drug use more dangerous in Ohio, what does the state government plan to do? Crack down some more, of course:

House Bill 93, which would require those prescribing opioids to be board certified in pain medicine, fine physicians who don't comply with the licensure, and would delineate how often doctors should check OARRS is up for a committee vote this week in the Senate.

Aside from whatever impact this restriction might have on the black market, it is bound to hurt patients suffering from severe pain, who will find it more difficult to get relief because far fewer doctors will be allowed to provide it. The Obama administration's plan to curtail nonmedical use of opioids, which I criticized in a column last month, poses a similar danger.

In a 2003 Reasonarticle, I noted that heroin's hazards are largely (though not entirely) due to prohibition.